University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Missionsstrasse 62A, CH-4055 Basel, Switzerland; Technische Universität Dresden, Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187 Dresden, Germany.
German Rheumatism Research Centre Berlin, Leibniz Institute, Epidemiology Unit, Charitéplatz 1, 10117 Berlin, Germany; Charité Universitätsmedizin Berlin; Institute for Social Medicine, Epidemiology and Health Economics, Luisenstraße 57, 10117 Berlin, Germany.
Behav Res Ther. 2017 Apr;91:64-71. doi: 10.1016/j.brat.2017.01.013. Epub 2017 Jan 24.
Psychological flexibility theory (PFT) suggests three key processes of change: increases in value-directed behaviors, reduction in struggle with symptoms, and reduction in suffering. We hypothesized that Acceptance and Commitment Therapy (ACT) would change these processes and that increases in valued action and decreases in struggle would precede change in suffering.
Data were derived from a randomized clinical trial testing ACT (vs. waitlist) for treatment-resistant patients with primary panic disorder with/without agoraphobia (n = 41). Valued behavior, struggle, and suffering were assessed at each of eight sessions.
Valued actions, struggle, and suffering all changed over the course of therapy. Overall changes in struggle and suffering were interdependent whereas changes in valued behavior were largely independent. Levels of valued behaviors influenced subsequent suffering, but the other two variables did not influence subsequent levels of valued action.
This finding supports a central tenet of PFT that increased (re-)engagement in valued behaviors precedes reductions in suffering. Possible implications for a better understanding of response and non-response to psychotherapy are discussed.
心理灵活性理论（PFT）提出了三种关键的变化过程：增加价值导向行为、减少与症状的斗争以及减少痛苦。我们假设接纳与承诺疗法（ACT）会改变这些过程，并且增加有价值的行动和减少挣扎会先于痛苦的改变。
数据来自于一项随机临床试验，该试验测试了针对有/无广场恐惧症的原发性恐慌障碍的治疗抵抗患者的 ACT（与等待名单对照）（n=41）。在八次治疗过程中，对有价值的行为、挣扎和痛苦进行了评估。
有价值的行为、挣扎和痛苦都在治疗过程中发生了变化。总的来说，挣扎和痛苦的变化是相互依存的，而有价值的行为的变化则在很大程度上是独立的。有价值行为的水平影响随后的痛苦程度，但其他两个变量并不影响随后的有价值行为水平。
这一发现支持了 PFT 的一个核心原则，即增加（重新）参与有价值的行为先于痛苦的减少。对理解心理治疗的反应和非反应可能有更好的理解，这一发现具有潜在的意义。
